Effect of abbreviated upright Behavioral Relaxation Training (BRT)
on two self-report measures of test anxiety was examined using a
quasi-experimental pre-post between groups (N = 20) research design with
self-referred college students. At time 1 (T1) assessment, all
participants completed the Abbreviated Test Anxiety Scale (ATAS) and
were trained in the use of the Subjective Unit of Discomfort (SUD)
rating scale. Participants recorded SUD ratings in vivo over a one-week
period. Experimental group participants received two group sessions of
upright BRT with instructions to practice BRT in vivo. Control group
participants simply recorded SUD ratings during the intervention period.
At time 2 (T2) assessment, all participants provided SUD rating data and
completed the ATAS. Correlated t-tests indicated statistically
significant differences in ATAS and SUD ratings in favor of abbreviated
BRT. Robust effect, despite small sample size, provides further evidence
for the effectiveness of BRT as an easy to learn, rapid relaxation
training procedure for anxiety disorders. Application of abbreviated BRT
in a group setting is a significant advance. Replication using a larger
sample size with measurement of relaxed behavior and effect on academic
performance is needed.

Keywords: Behavioral relaxation training, anxiety, controlled
study.

Introduction

Within the scientific community there is broad agreement that test
anxiety negatively affects academic performance (Zeidner, 1998) across
the educational spectrum from primary to college levels (Hembee, 1988;
Siepp, 1991). The conclusion, based on numerous meta-analyses, is that
approximately two-thirds of low-test anxious students will score higher
that the average high-test anxious student (Schwarzer, 1990). In a large
sample of undergraduate students, Chapell, Blanding and Silverstein et
al (2005) reported that high-test anxious college students score
one-third letter grade lower (e.g., from a B+ to B). In addition,
females consistently report higher test anxiety. Unfortunately, because
test anxiety is not a DSM diagnosis (Diagnostic and Statistical Manual
for Mental Disorders, 1997), little systematic research has been
conducted to identify empirically valid measures and interventions for
test anxiety.

Recently, test anxiety has been conceptualized as a type of
performance anxiety (Powell, 2004a). Performance anxiety is most closely
associated with social phobia; however, the characteristics of
performance anxiety related to completion of tests or examinations are
different and allow differential diagnosis. Relative to test anxiety:
(a) the anxiety is debilitating, (b) though overall impairment is
limited, (c) fear is restricted to specific performance situations, (d)
self-established standards of performance are high, (e) fear of scrutiny
is limited, (f) anticipatory anxiety is variable, and (g) the individual
remains committed to performing the feared task (Powell, 2004a).
Nonetheless, there is some likelihood that debilitating test anxiety may
co-occur with other behavioral disorders such as specific phobia and
general anxiety disorder. Precise data on this relationship remain
elusive.

Despite lack of consensus regarding whether test anxiety is a
subtype of performance anxiety or an anxiety disorder not other wise
specified, a large number of students experience significant anxiety
during test taking situations. Indeed, the ubiquity of test anxiety on
college campuses has resulted in university counseling centers
frequently offering services for test anxiety management. While
traditional psychotherapy may still be used by some mental health
counselors for test anxiety, at best, its effectiveness is extremely
limited. The data are equivocal with respect to psychotherapy/counseling
reducing anxiety; however, it is unequivocal in demonstrating that
psychotherapy/counseling has no effect on performance (Smith, Armkoff,
& Wright, 1990). Furthermore, evidence-based research related to
anxiety management indicates that behavioral and cognitive behavioral
interventions have the strongest empirical support (Chambless, Baker,
Baucom, et al., 1998), with each decreasing anxiety and improving
performance. Moreover relaxation training, typically using abbreviated
progressive relaxation training (Bernstein & Borkovek, 1973) is a
common component of either behavioral or cognitive behavioral mental
health counseling intervention to decrease arousal. For example,
Hudesman, Loveday and Woods (1984) reported that systematic
desensitization decreased anxiety and improved grade point average.
Powell (2004) reported the effectiveness of a treatment package that
included relaxation training, systematic desensitization,
psychoeducation and study skills for medical students with test anxiety.

Behavioral Relaxation Training (BRT; Poppen, 1998) is a behavior
analytically based procedure used for teaching 10 overt relaxed
behaviors. Behavioral skill training (i.e., verbal instruction,
modeling, prompting, reinforcement, shaping, and corrective feedback) is
employed in acquisition and proficiency phases of training. Participants
are taught 10 relaxed behaviors, each with an operational definition:
head, eyes, throat, shoulders, hands, body, feet, breathing, mouth and
quiet. Relaxed postures have been validated and shown to produce
decreased electromyographic (EMG) activity (Poppen & Maurer, 1984).
During proficiency training, participants are taught to covertly observe
and discriminate interoceptive, proprioceptive, and kinesthetic stimuli
produced by performance of overt relaxed behavior. For example, the
client is instructed to "notice the sensations as you relax your
hand in the curled, claw-like position on the arm of the chair." As
in acquisition training, correct overt performance of the relaxed
behavior is reinforced using descriptive praise. BRT has been used to
manage tremor severity and anxiety of patients with essential tremor (ET) and Parkinson's disease (Lundervold & Poppen, 2004;
Lundervold, Pahwa & Lyons, In press; Lundervold, Pahwa, & Lyons,
2006). Rashid and Parish (1998) conducted group BRT or abbreviated
progressive relaxation training with high school students. Both
relaxation training procedures reduced self-reported state anxiety.
These authors concluded that "behavioral relaxation may actually be
the more desirable of the two approaches, since it is less physically
taxing in the sense that trainees do not have to tense and relax muscles
routinely, as they do while they are engaging in progressive
relaxation" (pp. 100).

Because of the increasing demand for accountability and
evidence-based counseling outcomes (Sexton, 1999; Sexton Schofield,
& Whiston, 1997; Sexton, Whiston, Bleuer, & Walk, 1997), mental
health counselors must be employ counseling interventions with
demonstrated effectiveness (Chambless, Baker, Baucom, et al., 1998;
Wampold, Lichtenberg, & Waehler, 2002). BRT, implemented over six to
eight sessions, has been shown to reduce anxiety and improve performance
(Lundervold, In press; Poppen, 1998). In addition, the the relaxed
behaviors are directly observable and measurable (Poppen, 1998)
providing mental health counselors an opportunity to directly measure
the process of behavior change functionally related to symptoms
complaints. In doing so, further evidence-based care can be documented
as well as identifying variables responsible for improvement in
functioning. While encouraging, further research is needed to establish
BRT as effective intervention for anxiety disorders. This research
extends previous findings related to BRT and anxiety by examining the
effect of abbreviated upright BRT on test anxiety of college-age
students.

Method

Participants

Twenty (N = 10 per group), self-referred, undergraduate university
students reporting test anxiety, took part. The majority of participants
were Caucasian (66%) females students with the remaining sample
comprised of African American females. Two African American participants
were enrolled in the experimental condition and three enrolled in the
control condition. Participants ranged in age from 18-40 years old.
Participants volunteered to take part by enrolling in the research using
an online research web page and assigned to groups based on the session
schedule posted. The research was conducted at a small Midwestern
university as part of an undergraduate research course requirement.

Dependent variables

A 10-point Subjective Unit of Discomfort (SUD) rating (Wolpe,
1958), obtained in vivo, was used as an idiographic process measure of
behavior change. Higher SUD ratings indicate greater subjective
discomfort. A slightly revised version of the nine-item Abbreviated Math
Anxiety Scale (Hopko, Mahadevan, Bare, & Hunt, 2003) was used as a
generic outcome measure of test anxiety. Scores could range from 9-45
with higher scores indicating greater test anxiety. The original math
anxiety scale has excellent reliability and validity.

A pre-post between groups quasi-experimental design was used.
Independent t-tests were used to assess differences on pre test ATAS
scores followed by a comparison of post test ATAS and one randomly
selected SUD rating. One SUD rating was selected due to the varying
number of ratings recorded as a function of the frequency of
quizzes/exams.

Procedure

A senior-level, female undergraduate student in psychology, with
course work in Principles of behavior and Cognitive behavioral
intervention, implemented procedures and collected all data. The initial
session was conducted individually. After obtaining informed consent,
assignment to BRT and control group occurred based on schedule
availability. All participants completed a brief demographic
questionnaire and the ATAS (Time 1). Participants assigned to the
control condition received instructions to make SUD ratings before an
exam or quiz while in the classroom.

Participants assigned to the BRT condition received the same
instruction in addition to two 30-minute sessions of abbreviated upright
BRT. Upright relaxed behaviors were taught in a group setting.
Acquisition training of upright relaxed behavior was conducted during
the first 30-minute period using behavioral skill training followed by
behavioral rehearsal (Poppen, 1998). A short break then ensued.
Proficiency training was conducted during the second 30-minute period.
Participants were instructed engage in the upright relaxed behaviors.
The trainer then instructed participants to notice "how it feels to
relax your (behavior) in the (relaxed position based on the operational
definition)" with contingent corrective feedback or descriptive
praise provided. At time 2 (T2) assessment, conducted one week later,
all participants again completed the ATAS and returned SUD ratings
obtained over the past week.

Results

Frequency of SUD ratings ranged from one to four in the interim
between T1 and T2. An independent t-test on BRT and control group
pre-test mean ATAS scores was non significant (p = > .10). An
independent t-test conducted comparing mean T2 ATAS scores and SUD
ratings of the BRT and control group found a significant difference
between groups (ATAS: t(15)=1.38, p<.05; SUD: t(15)=.62, p<.05).
Mean ATAS for the BRT group was significantly lower (m=18, sd=3.65) than
the for the control group (m = 22.4, sd = 2.84). Mean SUD rating for the
BRT group was also significantly lower (m = 4.4, sd = 2.37) compared to
the control group (m = 6.7, sd = 1.57).

Discussion

Test anxiety among college students is a prevalent maladaptive response that can have deleterious effects on emotional as well as
academic performance. Upright abbreviated BRT was found to be effective
reducing test anxiety using outcome (ATAS) and process measures (SUD
rating). Results replicate and extend past research on BRT. Rashid and
Parish (1998) reported the benefits of four sessions of upright BRT with
high school students. Unfortunately, these students did not report test
anxiety, but were merely recruited to take part in a relaxation study.
Analog studies of this type have limited generality to actual clinical
populations. Participants in our study reported a clinically meaningful
degree of distress on two measures of test anxiety. Positive effects of
BRT were obtained in two sessions. The brevity and effectiveness of BRT
in a group setting are very encouraging for its use in managing test
anxiety among college students. These results also replicate and extend
the findings of Lundervold et al (In press) demonstrating that BRT is
effective in reducing anxiety among neurologically and non-impaired
individuals.

The brief period between T1 and T2 limits statements about the
durability of upright abbreviated BRT for managing test anxiety.
Furthermore, the modified ATAS, though based on a math anxiety
questionnaire with excellent reliability and validity, has no
demonstrated psychometric characteristics. It is possible that ATAS
results are unreliable; however, between group SUD ratings, an
idiographic measure of the process of behavior change, were
significantly different. This finding supports ATAS results. Further
research establishing the psychometric properties of the ATAS is needed.
Replication of the effect of abbreviated upright BRT for test anxiety
using larger samples, direct measure of relaxed behavior and assessment
of academic change also is needed.